Measles virus outbreak: a new concern for public health, pathogenesis, diagnosis, genomic features, and treatment criteria – correspondence
Authors: Shopnil Akash, Md. Rezaul Islam, Md. Mominur Rahman
Journal: International Journal of Surgery (2023)

Dear Editor, The measles is an airborne respiratory infection which, is very aggressive, may lead to serious problems, some of which can be lifelong, and is still responsible for considerable childhood morbidity and mortality around the globe. These implications may include pneumonia, convulsions, brain damage, and even death. The virus responsible for measles infections is communicable and rapidly transmits through the air due to breathing, coughing, and sneezing, and it dwells in the nasal and throat mucus of an infectious person. When a person with measles coughs, sneezes, or speaks, contaminated droplets shoot into the air (where other people might inhale them) or fall on a surface, where they stay active and infectious for many hours. Others may get infected if they breathe the contaminated air or contact the infected surface and then touch any part of their face, including their eyes, noses, or mouths. Because of how infectious measles is, if one person gets it, up to 90% of the others in close proximity to that person who do not have immunity to the disease will also become sick. People who are infected with measles may pass the virus on to others beginning 4 days before the rash shows and 4 days after it has appeared1. According to estimates, three to four million Americans catch the disease annually. Each year, measles is responsible for an estimated 400–500 annual deaths, 48 000 annual hospitalizations, and 1000 annual instances of encephalopathy (brain swelling)2. Recent measles outbreaks have put millions of lives at risk, especially in several Indian states where the disease has seen a dramatic uptick. Furthermore, the WHO has said that a single case might result in between 12 and 18 additional infections3. The WHO also said that measles has emerged as a major international health concern. Hindustan Times reports, citing persons acquainted with the situation, that in response to the escalating number of cases, the federal government has urged afflicted states to increase monitoring for fever and rash. The Union’s Health Ministry has been pressuring individual states to increase monitoring efforts to ensure no new cases go undetected and that those already known about get prompt treatment. An anonymous government insider informed of the situation told HT that this will help save lives4. There has been an uptick in measles infections in both Maharashtra and Kerala. Most of the state’s 807 measles cases and 18 associated fatalities were reported in the Mumbai Metropolitan Area, according to a health department advisory released on 3 December. A 1-year-old child in Mumbai died from measles earlier in November 2022. The Malappuram district in Kerala recorded 160 cases of measles on November 305. A high fever is often the first indication that a person has measles (Fig. 1). This fever typically develops 10–12 days after an individual has been exposed to the virus and may continue anywhere from 4 to 7 days. In the first stage, symptoms like a cough, a runny nose, eyes that are red and watery, and little white patches on the inside of the cheeks may appear. After a few days have passed, a rash will often appear over the person’s face and upper neck. The rash becomes more widespread over the course of roughly 3 days, finally reaching the hands and feet. The rash might linger for up to 6 days before it starts to clear up. The rash appears around 14 days after first viral contact on average (within a range of 7–18 days). The majority of fatalities that are attributed to measles are the result of complications that are connected with the illness. Children less than 5 years old and adults older than 30 years old have a much higher risk of experiencing serious problems. The most significant problems include blindness, encephalitis (an illness that causes the brain to enlarge), severe diarrhea and the accompanying dehydration, ear infections, or severe respiratory infections such as pneumonia. Blindness is one of the most dangerous complications. Children under the age of five who are malnourished, particularly those with low levels of vitamin A or whose immune systems have been compromised by HIV/AIDS or another illness, have an increased risk of developing a severe form of measles7.Figure 1: Measles cases reported 2010–2022 (as of 22 December 2022)6.The measles virus is the causal agent, and it is an enveloped virus that carries a negative-sense single-stranded RNA genome. It belongs to the genus Morbillivirus and the family Paramyxoviridae. There are a number of variable areas in the MV genome that have been utilized to classify the virus into eight clades (A–H) and then into 24 genotypes (2). Six structural proteins (N, P, M, F, H, and L) and two nonstructural proteins are encoded by the MV genome8. The RNA genome of the measles virus is around 16 000 nucleotides long and is encased in a lipid envelope that is produced from the host cell. In all, eight proteins are coded for by the genome, two of which (V and C) are nonstructural proteins transcribed from the phosphoprotein (P) gene. The nucleocapsid, which contains viral RNA, is formed by the six structural proteins P, L, and N. Hemagglutinin (H), fusion (F), and matrix (M) proteins, as well as lipids from the host cell membrane, combine to form the viral envelope1. Measles is primarily detected by looking for the telltale skin rash, checking for evidence of Koplik’s spots in the mouth (small white spots on the cheeks), and observing other symptoms such as a hacking cough, sore throat, and fever. When the doctor is unable to diagnose patients based on the indications alone, he or she may recommend a blood test (drawing a small amount of blood to be analyzed in a lab) to make a final determination. A PCR test of the urine or a throat swab (to detect viruses) may help confirm the diagnosis (PCR)9. There is currently no cure or medication for measles infections. As a part of treatment, patients may be offered relaxation to alleviate symptoms and other forms of comfort care. Young, unvaccinated children are most vulnerable to measles and have the biggest risk of developing difficulties from the disease, including death. Women who are pregnant but have not had the appropriate vaccinations are also at danger10. The measles virus infection is possible in everyone who does not have immunity to the disease (either because they have not been vaccinated or because they have been vaccinated but do not have immunity as a result of the vaccine). Vaccinating children against measles on a routine basis and conducting mass immunization campaigns in nations with high case and death rates are two of the most important public health measures that can be taken to minimize the number of fatalities caused by measles across the world. Ethical approval Not applicable. Sources of funding Not applicable. Author contribution S.A.: conceptualization, writing – original draft preparation. Md.R.I., Md.M.R.: writing, editing. All authors have reviewed and approved the final version of the manuscript prior to submission. Conflicts of interest disclosure The authors declare no conflict of interest, financial, or otherwise. Research registration unique identifying number (UIN) 1. Name of the registry: not required. 2. Unique identifying number or registration ID: not required. 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): not required. Guarantor Md. Mominur Rahman (corresponding author), is taking full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. Data availability statement All data are available within the manuscript.